Treatment-Resistant Depression

These are the most common symptoms of depression. However, each person may have slightly different symptoms:

• A lasting sad, anxious or empty mood
• Weight or appetite changes because of eating too much or too little
• Changes in sleeping patterns, including fitful sleep, inability to sleep, early morning awakening, or sleeping too much
• Loss of interest and pleasure in activities formerly enjoyed, including sex
• Increased restlessness and irritability
• Decreased energy, fatigue and being "slowed down"
• Physical symptoms, such as headaches, digestive problems, or chronic pain that doesn’t get better with treatment
• Feelings of worthlessness or helplessness
• Lasting feelings of hopelessness
• Feelings of inappropriate guilt
• Problems concentrating, thinking, or making decisions
• Frequent thoughts of death or suicide, or wishing to die

There is no clear cause of depression. Experts think depression happens because of chemical problems in the brain. Many factors can play a role in depression. These include environmental, mental health, physical and inherited factors.

Some types of depression seem to run in families. But no genes have yet been linked to depression. People of all ages can suffer from depression that is serious and greatly affects their lives.

Women tend to have depression about twice as often as men. Many hormonal factors may add to the increased rate of depression in women. This includes menstrual cycle changes, premenstrual syndrome, pregnancy, miscarriage, postpartum period, perimenopause and menopause. Many women also deal with additional stresses, such as responsibilities both at work and home, single parenthood and caring for both children and aging parents.

Many women are especially at risk after giving birth. Women have hormonal and physical changes on top of the added responsibility of caring for a baby. These factors can lead to postpartum depression in some women. The “baby blues" are common in new mothers and last a week or two. A full-blown depressive episode — known as major depressive disorder — is not normal and needs treatment.

Depression can occur alone or with other health problems, such as disabling injuries, heart disease, cancer, or diabetes. Middle-aged and older adults with these conditions are at particular risk for depression. It can also happen with other mental health disorders, such as substance abuse or anxiety disorders. Getting an early diagnosis and treatment is important to recovery.

A psychiatrist or other licensed mental health provider can make a diagnosis after a careful mental health exam and health history.

Depression has different forms, just like many other illnesses. Here are the types of depressive disorders:

• Major depressive disorder (clinical depression): This includes symptoms of depression most of the time for at least two weeks that affect your ability to work, sleep, eat and enjoy life. It can put you out of action for a while. These episodes of depression can happen once, twice or several times in a lifetime.
• Dysthymia: Also known as persistent depressive disorder, this condition is a long-term (chronic) depressed mood and has other symptoms that are not as severe or extensive as those in major depression. These symptoms can still keep you from functioning at "full steam" or from feeling good. People with dysthymia sometimes also have major depressive episodes.
• Bipolar disorder: This long-term (chronic) condition includes cycles of extreme lows (depression) and extreme highs (hypomania or mania).
• Perinatal depression: This happens when a pregnant person experiences major depression during pregnancy or after delivery (called postpartum depression).
• Seasonal affective disorder: This comes and goes with the seasons. It usually starts in late fall and early winter and goes away during spring and summer.
• Depression with psychosis: This is not as common as other types of depression. It is a severe form of depression where a person may experience delusions or hallucinations.